From the Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute (NDT, CCL, ML, ST, CV, GL, AZ, FM), Department of Anaesthesia, Mexico Hospital, San Josè, Costa Rica (LEAC) and Vita-Salute San Raffaele University, Milan, Italy (GL, AZ).
Eur J Anaesthesiol. 2021 Apr 1;38(4):402-410. doi: 10.1097/EJA.0000000000001437.
Organ perfusion is a factor of cardiac output and perfusion pressure. Recent evidence shows that dynamic arterial elastance is a reliable index of the interaction between the left ventricle and the arterial system and, in turn, of left ventricular mechanical efficiency. A practical approach to the assessment of dynamic arterial elastance at the bedside is the ratio between pulse pressure variation and stroke volume variation, which might predict the effect of a fluid challenge on the arterial pressure in patients undergoing cardiac surgery.
To evaluate the ability of dynamic arterial elastance, measured by the pressure recording analytical method (PRAM), to predict the response of mean arterial pressure (MAP) to a fluid challenge.
Prospective observational study.
Cardiac surgery patients in a university hospital.
Preload-dependent (pulse pressure variation ≥13%), hypotensive (MAP ≤65 mmHg) patients, without right ventricular dysfunction, at the end of cardiac surgery.
A 250 ml fluid challenge infused over 3 min.
A receiver-operating characteristic curve was generated to test the ability of the baseline (before fluid challenge) dynamic arterial elastance (primary endpoint) and all other haemodynamic variables (secondary endpoint) to predict MAP responsiveness (≥10% increase in MAP) after a fluid challenge.
Of 270 patients undergoing cardiac surgery, 97 (35.9%) were preload-dependent, hypotensive and received a fluid challenge. Of these 97 patients, 50 (51%) were MAP responders (≥10% increase in MAP) and 47 (48%) were MAP nonresponders (<10% increase in MAP). Baseline dynamic arterial elastance (mean ± SD) had an area under the curve of 0.64 ± 0.06 [95% confidence interval (CI), 0.53 to 0.73; P = 0.017]. A dynamic arterial elastance at least 1.07 with a grey zone ranging between 0.9 and 1.5 had 86% sensitivity (95% CI, 73 to 94) and 45% specificity (95% CI, 30 to 60) in predicting MAP increase.
In a hypotensive preload-dependent cardiac surgery cohort without right ventricular dysfunction, dynamic arterial elastance measured by PRAM can predict pressure response for values greater than 1.5 or less than 0.9.
器官灌注是心输出量和灌注压的一个因素。最近的证据表明，动态动脉弹性是左心室与动脉系统相互作用的可靠指标，进而也是左心室机械效率的可靠指标。在床边评估动态动脉弹性的一种实用方法是脉搏压变化与每搏量变化的比值，该比值可以预测心脏手术患者的液体挑战对动脉压的影响。
评估通过压力记录分析方法（PRAM）测量的动态动脉弹性预测平均动脉压（MAP）对液体挑战反应的能力。
前瞻性观察性研究。
大学医院的心脏手术患者。
心脏手术后，依赖前负荷（脉搏压变化≥13%）、低血压（MAP≤65mmHg）、无右心室功能障碍的患者。
在 3 分钟内输注 250ml 液体挑战。
生成受试者工作特征曲线，以测试基线（液体挑战前）时的动态动脉弹性（主要终点）和所有其他血流动力学变量（次要终点）预测液体挑战后 MAP 反应性（MAP 增加≥10%）的能力。
在 270 例接受心脏手术的患者中，97 例（35.9%）依赖前负荷、低血压并接受了液体挑战。在这 97 例患者中，50 例（51%）为 MAP 反应者（MAP 增加≥10%），47 例（48%）为 MAP 无反应者（MAP 增加<10%）。基线时的动态动脉弹性（平均值±标准差）曲线下面积为 0.64±0.06[95%置信区间（CI），0.53 至 0.73；P=0.017]。动态动脉弹性至少为 1.07，灰色区域范围在 0.9 至 1.5 之间，预测 MAP 增加的敏感性为 86%（95%CI，73%至 94%），特异性为 45%（95%CI，30%至 60%）。
在无右心室功能障碍的依赖前负荷的低血压心脏手术患者队列中，PRAM 测量的动态动脉弹性可以预测压力反应值大于 1.5 或小于 0.9。
